abstract: Laparoscopic and laparotomic staging in stage I epithelial ovarian cancer: a comparison of feasibility and safety - oncologic safety

Laparoscopic and laparotomic staging in stage I epithelial ovarian cancer: a comparison of feasibility and safety:

Abstract

The aim of this study was to compare laparoscopic and laparotomic surgical staging in patients with stage I epithelial ovarian cancer in terms of feasibility and safety. A retrospective chart review was undertaken of all patients with apparent stage I epithelial ovarian cancer who underwent laparoscopic (laparoscopy group) or laparotomic (laparotomy group) surgical staging at the Center for Uterine Cancer, National Cancer Center, Korea, between January 2001 and August 2006. During the study period, 19 patients underwent laparotomic surgical staging and 17 patients underwent laparoscopic surgical staging. No cases were converted from laparoscopy to laparotomy. The two groups were similar in terms of age, body mass index, procedures performed, number of lymph nodes retrieved, and operating time. The laparoscopy group had less estimated blood loss (P = 0.001), faster return of bowel movement (P < 0.001), and a shorter postoperative hospital stay (P = 0.002) compared to the laparotomy group. Transfusions were required only in two laparotomy patients, and postoperative complications occurred only in four laparotomy patients. However, two patients with stage IA grade 1 and 2 disease in laparoscopy group had recurrence with one patient dying of disease. The accuracy and adequacy of laparoscopic surgical staging were comparable to laparotomic approach, and the surgical outcomes were more favorable than laparotomic approach. However, the oncologic safety of laparoscopic staging was not certain. This is the first report on the possible hazards of laparoscopic staging in early-stage ovarian cancer. In the absence of a large prospective trial, this technique should be performed cautiously.

abstract: Study of the correlation between tumor size and cyst rupture in laparotomy and laparoscopy for benign ovarian tumor: Is 10 cm the limit for laparoscopy?

Blogger's Note: this paper is not designed (per abstract) to determine the outcomes of cyst/tumor rupture, rather how/when; research has indicated varied survival outcomes on tumor rupture (eg. prior to vs  during surgery)

 

Abstract

Aim:  Laparoscopy is the gold standard for treatment of benign ovarian cysts, although there is a risk of intraoperative cyst rupture if the lesion is cancerous. This study is aimed at comparing the incidence of cyst rupture to tumor size in both laparotomy and laparoscopy in order to select the optimum surgical procedure for ovarian cysts.

Methods:  A total of 1483 cases of benign ovarian cysts were surgically treated at our center between 1995 and 2010. These cases were divided into three groups according to the maximum diameter of the ovarian tumors: <5 cm, ≥5 cm but <10 cm, and ≥10 cm. The incidence of cyst rupture was compared between laparotomy and laparoscopy according to the size of the tumor in ovarian tumorectomy and adnexectomy.

Results:  The incidence of cyst rupture was significantly higher in ovarian tumorectomy by laparoscopy than by laparotomy. Cyst rupture occurred independent of the tumor size in both laparoscopy and laparotomy. For adnexectomy for tumors smaller than 10 cm, there was no significant difference by tumor size in the incidence of cyst rupture between laparoscopy and laparotomy; however, the incidence of cyst rupture was significantly higher in laparoscopy of tumors sized 10 cm or larger than in the laparotomy of tumors of similar size; the incidence was also greater than laparoscopy of tumors smaller than 10 cm.

Conclusion:  Laparotomy, rather than laparoscopy, is recommended in cases of ovarian cysts with any finding suggestive of malignancy.

eg.

Influence of Intraoperative Capsule Rupture on Outcomes in Stage I

Dec 26, 2008

OBJECTIVE:: To evaluate the effect of tumor capsule rupture on disease prognosis in stage I epithelial ovarian cancer. METHODS:: All patients with International Federation of Gynecology and Obstetrics stage I epithelial ...

http://ovariancancerandus.blogspot.com/

OVARIAN CANCER and US: ASCO 2011 abstract: A North ...

abstract: Complications of laparoscopic surgery

Complications of laparoscopic surgery

"Laparoscopic surgery is the standard of care for many gynaecological conditions with documented benefits and excellent outcomes for patients and healthcare providers. However, in addition to the general complications associated with surgery and anaesthesia, laparoscopy poses unique complications relating to abdominal entry and surgical instrumentation. Governing bodies, representing both the surgical specialities and gynaecology, have attempted to gain consensus on the safest technique for abdominal entry to no avail. Studies comparing techniques to date are underpowered and the likelihood of high-grade evidence ever becoming available is low due to the prohibitive patient numbers and costs. This review will examine complications of laparoscopy and current recommendations from surgical training organizations for abdominal entry in laparoscopic surgery."

Does surgical volume influence short-term outcomes of laparoscopic hysterectomy?

CONCLUSION: In laparoscopic hysterectomy, increasing the surgical volume can reduce the operating time and the risk for conversion to laparotomy but not the rate of serious complications